Endocrine Flashcards

Question

What are the causes of cranial Diabetes insipidus

Answer 1

Acquired - Idiopathic - Tumours - Surgery - Head injury - Granulomata - Infections - Vascular disorders - Post-radiotherapy Congenital - DIDMOAD - Autosomal recessive - DI, DM, Optic Atrophy and Deafness - Autosomal dominant mutations of vasopressin gene

Answer 2

Acquired - Idiopathic - Hypokalaemia - Hypercalcaemia - Chronic kidney disease - Other metabolic derangments - Drugs - Lithium, Orlistat, Ofloxacin - Renal tubular acidosis - Pregnancy - Post-obstructive uropathy Congenital - X-linked mutation in V2 ADH receptor gene - Autosomal recessive defect in AQP2 gene - Sporadic nephrogenic DI with general learning disability and intracerebral calcification (V rare)

Answer 3

Polyuria Polydipsia Nocturia Dehydration + Potential palpable bladder

Answer 4

``` Urine Osmolality - <300 Serum Osmolality - Normal or elevated Serum Na - Normal or elevated Serum K - Normal or low Serum Ca - Normal or elevated Urine dipstick - -ve for glycosuria 24hr Urine collection - >3L/24hrs ``` Water deprivation - 8hrs of water deprivation or until 3% of body weight is lost - Only performed if not hypernatraemic - Both types of DI will show that urine osmolality will be below 700 after the test (Some patients not show optimal concentration of urine because they have primary polydipsia) To distinguish between the 2 types of DI: Desmopressin stimulation test Central/Cranial DI will respond Nephrogenic DI will not

Answer 5

Hypernatraemia - Important complication Fluids - 0.45% Normal Saline, 5% Dextrose Central/Cranial Desmpression Nephrogenic Maintain adequate intake of water + Treat underlying cause

Answer 6

This is when there is hyponatraemia (<125) and low plasma osmolality (<260) with concentrated urine (>100; urine Na >20) in the absence of hypovolaemia, oedema or diuretics Primary cause is due to ADH secretion even though the plasma is concentrated (Low osmolality) <50% of severe hyponatraemia is caused by SIADH (It is over diagnosed)

Answer 7

Brain (6) - Haemorrhage/thrombosis - Meningitis - Abscess - Trauma - Tumour - Guillain-‐Barre syndrome Lung (3) - Pneumonia - TB - Other: Abscess, Aspergillosis, Small cell carcinoma ``` Tumours (4) - Small cell lung caner - Lymphoma - Leukaemia - Others: Pancreatic cancer, prostate cancer, mesothelioma, sarcoma, thymoma ``` Drugs (4) - Vincristine - Opiates - Carbamazepine - Chlorpropamide Metabolic (2) - Porphyria - Alcohol withdrawal

Answer 8

Mild: Usually Asymptomatic Moderate: Headache, N&V, Claudication, Irritability Severe: Confusion, Drowsiness, Convulsions, Coma

Answer 9

``` Diagnosis: Plasma osmolality - Low Urine osmolality - High Plasma Na - Low Urine Na - High Absence of hypovolaemia, oedema or diuretics ``` Things to check: - Creatinine - Renal function - Glucose, Protein, Lipids - Rule out pseudohyponatraemia (When sodium is reported as low due to high lipids or protein) - T4 and TSH - Hypothyroidism - Synacthen test - Adrenal insufficiency

Answer 10

- Treat the underlying cause - Fluid restriction - Vasopressin receptor antagonists - Vaptans (tolvaptan) Severe - Slow IV hypertonic saline and furosemide with close monitoring

Answer 11

Convulsions Coma Death - <110 Central pontine myelinolysis - Occurs with rapid correction of hyponatraemia - Quadriparesis - Respiratory arrest - Fits

Answer 12

1o - 95% Acquired: - Hashimoto's thyroiditis: Goitre due to lymphocytic and plasma cell infiltration. Potential initial state of hyperthyroid - Primary atrophic hypothyroidism - Diffuse lymphocytic infiltration of the thyroid, leading to atrophy, hence no goitre - Iodine deficiency - World wide main cause - Post-thyroidectomy or radio iodine treatment - Drugs induced: Amiodarone, lithium, iodine Congenital: - Thyroid dysgenesis 2o - 5% Pit-Hypo disease

Answer 13

``` Weakness + Lethargy Cold sensitivity Constipation Weight gain Depression Menstraul irregularity Myalgia Dry and coarse skin Facial oedema Thick tongue Bradycardia Deep voice Goitre Delayed tendon relaxation Diastolic hypertension with or without narrow pulse pressure ```

Answer 14

TFTs - 1o High TSH, Low T4, Lipids - Hyperlipidaemia and cholsterolaemia FBC - Macrocytosis

Answer 15

Levothyroxine - Rule out Addisons first - Check TSH after 4 weeks Myxoedema coma = IV T4/T3 - Oxygen - Rewarming - Rehydration - IV hydrocortisone - Treat underlying cause

Answer 16

Thyroiditis is inflammation of the thyroid Hashimoto's thyroiditis is an autoimmune condition that is the most common cause of hypothyroidism in the UK. Other types include: - de Quervan's thyroiditis - Postpartum thyroiditis - Drug-induced thyroiditis - Acute or infectious thyroiditis - Riedel's thyroiditis In Hashimoto's there is lymphocyte infiltration of the thyroid causing the formation of a goitre

Answer 17

Symptoms of hypothyroidism - Bradycardia - Constipation - Lethargy - Weakness - Weight gain - Los of appetite - Hair loss - Low mood - Menstrual irregularities - Cold intolerance - Dry skin Goitre formation leads to: - Dyspnoea - Dysphagia - Tenderness

Answer 18

- Serum TSH - High - Antibodies - Anti-TPO Abs + Anti-thyroglobulin Abs - Thyroid US - Radionuclide isotope scanning - Histology - Diffuse lymphocytic and plasma cell infiltration with formation of lymphoid follicles

Answer 19

Pharmacological Levothyroxine - Titre based on patients need Surgical If there is a large goitre that is impeding on the surrounding structures

Answer 20

2o Hyperthyroid Hyperlipidaemia Myxoedema coma Hashimoto's encephalopathy

Answer 21

Micro-adenoma - <1cm Macro-adenoma - >1cm Giant Pituitary adenoma - >4cm Malignant Prolactinoma (Rare) Association to MEN-1 syndrome There is a risk of tumour enlargement in pregnancy

Answer 22

Women - Amen/Oligomen - Galactorrhea - Osteoporosis - Low libido - Hirsuitism - Infertility Men - ED - Reduced beard growth - Low libido Tumour size - Headache - Visual field defects - CN palsies - Pituitary stalk compression

Answer 23

Serum prolactin - Elevated Visual fields - Bitemporal hemianopia MRI Pituitary - Prolactinoma TFTs - High TRH can cause hyperprolactinaemia

Answer 24

Men Dopamine agonist Transphenoidal surgery Sellar radiotherapy ``` Women Dopamine agonist Combined oral contraceptive (If not desiring pregnancy) Transphenoidal surgery Sellar radiotherapy ```

Answer 25

Osteoporosis ED Infertility

Answer 26

This is partial or complete reduction in secretion of 1 or more anterior pituitary hormone Panhypothyroidism is deficiency in all pituitary hormones

Answer 27

- Pituitary masses - Pituitary trauma - Radiation, surgery, fracture - Hypothalamic dysfunction - Anorexia, Kallman's, starvation, over-exercise - Infiltrative disease - Sarcoidosis, Haemochromatosis, Langerhans' cell histiocytosis - Vascular - Pituitary apoplexy, Sheehan's syndrome - Infection - Genetic mutation - Pit-1 and PROP-1 genes

Answer 28

Depends on the hormone affected GH - Short stature in children - Low mood + Fatigue + Reduced exercise capacity and strength + Increased fat in adults LH or FSH - Delayed puberty, Decreased libido, Loss of 2o sexual hair - Females: Breast atrophy + Amen/Oligomen + Painful sex, Infertility - Males: Testicular atrophy + Gynaecomastia, Impotence ACTH - Adrenal insufficiency TSH - Hypothyroidism Prolactin - Not clinically noticed Apoplexy: Headache Visual loss CN palsies

Answer 29

``` PFTs 9am Cortisol + ACTH - Both low LH + FSH - Both low Testosterone - Low Oestrogen - Low IGF-1 - Low Prolactin - Slightly elevated Free T4 and TSH level - Low High serum and urine osmolality Low sodium ``` Insulin induced hypoglycaemic - GH and Cortisol will show no increase MRI Pituitary Visual field testing

Answer 30

Hormone replacement: - Hydrocortisone - Levothyroxine - Testosterone in males - Oestrogen with/without progesterone in females - Growth hormone - Somatropin - Desmopressin

Answer 31

``` Addisonian crisis Myxoedema coma Infertility Osteoporosis Dwarfism ``` Bitemporal hemianopia Hydrocephalus Temporal lobe epilepsy

Answer 32

High: Total cholesterol and/or LDL cholesterol and/or Triglycerides

Answer 33

Primary - Inherited - Familial Dyslipidaemias - Familial Hypercholesterolaemia - Familial combined Hyperlipidaemia - Apoprotein disorders Acquired - Saturated/Trans fat diets - Obesity - Medical conditions: Hypothyroidism + Obstructive jaundice + Cushing's syndrome + Anorexia nervosa + Nephrotic syndrome + DM + CKD - Drugs: Thiazide diuretics + Glucocorticoids + Ciclosporin + Antiretroviral therapy + Beta-Blockers + Combined oral contraceptive pill + Atypical antipsychotics + Retinoic acid derivatives. - Pregnancy - Alcohol use

Answer 34

- Premature corneal arcus - Tendon xanthomata or Xantholasma Familial Hypercholesterolaemia: High total cholesterol + Hx of premature CHD Confirm with 2 high fasted LDL-Cs

Answer 35

- Lipid profile - TChol, LDL-C, TGs - High - Fasting blood glucose - Exclude Hyperlipidaemia secondary to DM - Renal function - Exclude CKD - LFTs - Exclude Liver disease so statins can be given - TSH - Exclude Hypothyroidism DNA testing - Familial disease

Answer 36

Lifestyle changes | Statins - Atorvastatin

Answer 37

High CHD risk | Pancreatitis

Answer 38

1o hyperparathyroidism - Increased secretion of PTH unrelated to the plasma calcium concentration - Adenoma, hyperplasia, carcinoma, MEN syndrome 2o - Increased secretion of PTH secondary to hypocalcaemia - Chronic renal failure, Vitamin D Deficiency 3o - Autonomous PTH secretion following chronic 2o hyperparathyroidism

Answer 39

Many people have mild hypercalcaemia and it is asymptomatic Symptoms of Primary: Stones: Kidney/Gallstones Thrones: polyuria Bones: Bone pain + Hx Osteopenia/osteoporosis Groans: Constipation + Myalgias + Muscle cramps Psychiatric overtones: Anxiety + Depression + Memory loss Symptoms of Secondary & Tertiary: The same + bone resorption leading to renal osteodystrophy + Calcification in blood vessels + soft tissue

Answer 40

PTH - High Calcium - 1o & 3o High, 2o Low Phosphate - 1o Low, 2o High Vitamin D - 2o Low Renal ultrasound - Osteodystrophy

Answer 41

1o or 3o Parathyroidectomy + Vitamin D supplementation or Bisphophonate - Alendronic acid treat osteoporosis Calcimimetic - Cinacalcet + Vit D 2o Surgery Vitamin D supplementation

Answer 42

This is low bone mineral content after epiphyseal closure

Answer 43

Vitamin D deficiency - Due to malabsorption + poor diet + lack of sunlight + Decreased 25‐hydroxylation (due to liver disease or anticonvulsants) + Decrease 1a‐hydroxylation (due to CKD hypoparathyroidism) + Vitamin D resistance Tumour-induced osteomalacia

Answer 44

Bone pain (mainly in the axial skeleton) Weakness Malaise

Answer 45

Bone tenderness Proximal myopathy Waddling gait Signs of hypocalcaemia: - Trousseau's - Inflation of a blood pressure cuff to above the systolic pressure for >3 mins causes tetanic spasm of the wrist and fingers - Chvostek's - Tapping over the facial nerve causes twitching of the ipsilateral facial muscles

Answer 46

``` Bloods: Low Ca Low phosphate Low Vitamin D High PTH (2o Hyperparathyroidism) LFTs: High ALP U&Es: May be deranged ``` X-ray - Looser zones - Pseudo-fractures DXA - Low bone density Iliac crest biopsy with double tetracycline labelling - Reduced distance between tetracycline bands

Answer 47

If deficient Calcium + Vitamin D Calcium + Vitamin D metabolite/DHT Phosphate wasting + Phosphate too

Answer 48

CATs go NUMB Convulsions Arrhythmias Tetany Numbness/paraesthesias Depression Overcorrection problems

Answer 49

Hyperglycaemia caused by absolute insufficiency of pancreatic insulin production 10% of people with diabetes have T1DM

Answer 50

Type 4 hypersensitivity response (Cell mediated) against the Beta cells in the islet - Autoimmune destruction The autoantibodies associated with T1DM: - Glutamic acid decarboxylase (GAD) - Insulin - Insulinoma-associated protein 2 - Cation efflux zinc transporter

Answer 51

HLA-DR3/4 | >90% Association

Answer 52

This is latent autoimmune diabetes of adults and is a form of type 1 DM

Answer 53

``` Juvenile onset <30yrs Polyuria/Nocturia Polydipsia Glycosuria Weight loss Polyphagia ``` Other autoimmunities: Vitiligo Hashimoto's Thyroiditis Addison's

Answer 54

- Random plasma glucose - >11mmol/L - Fasting plasma glucose - 8hr fast - >6.9mmol/L - 2hr plasma glucose - 75g Glucose load - >11mmol/L - Plasma or urine ketones - Medium or high quantity - HbA1c - Reflects hyperglycaemic control over the preceding 3 months - Fasting C-peptide - Low or undetectable - Autoimmune markers - Positive

Answer 55

Insulin! - Basal-Bolus insulin Basal - Glargine - SC usually at night daily Bolus - Lispro/Aspart - Before meals depending on meal size and amount of carbs in meal Total per day 0.2-0.4 units/kg/day - Half given as Basal doses and half given as Bolus - Correction dose based on pre-meal blood glucose - Amylin analogue - Pramlintide - Prolongs gastric emptying so glucose levels don't spike as much Pregnant - Basal-Bolus - Low dose aspirin

Answer 56

``` Diabetic ketoacidosis Hypoglycaemia Retinopathy Nephropathy Neuropathy CVD ```

Answer 57

Excess Ketoacidosis production from lipolysis due to the lack of glucose being taken up into the adipose cells. This is a serious complication of T1DM The combination of hyperglycaemia and Ketoacidosis can be fatal and is a medical emergency - Bicarbonate below 15 or venous pH less than 7.3 - Blood glucose over 11 (Or known DM) - Ketonaemia >3 or significant ketonuria Hyperglycaemia is not always present and low blood kentone levels do not exclude DKA

Answer 58

``` Infection Discontinuation of insulin Inadequate insulin CVD - Stroke/MI Drug treatments - Steroids, Thiazide diuretics, SGLT2 inhibitors ```

Answer 59

- Kussmaul respiration - Deep breathing to reduce CO2 in blood - Ketotic breath - N+V - Dehydration - Mental status changes - Abdominal pain - Polyuria - polydipsia - Lethargy - Coma Signs of dehydration - Dry mucous membranes - Decreased skin turgor/skin wrinkling - Sunken eyes - Slow capillary refill - Tachycardia with weak pulse - Hypotension

Answer 60

- Plasma glucose - Elevated - ABG - pH 7-7.3 - Serum Ketones - Elevated - Urinalysis - +ve for glucose and ketones - U+Es - Elevated urea and creatinine + Low Na/Cl/Mg/Ca + High K/Phos - Anion gap - Na-Cl+HCO3 - >10-12 - Creatine phosphokinase - Elevated in Rhabdo - Lactate - Elevated in lactic acidosis - Amylase - Elevated - FBC - Elevated WCC - CXR - Pneumonia - ECG - May show evidence of MI

Answer 61

1L 0.9% Saline over 1hr If SBP under 90mmHg then give 500ml bolus STAT if persistent give another 500ml and seek senior review 50 units soluble insulin in 50ml of 09.% Saline. Continuously at 0.1 unit/Kg/h. - Fall in Ketones of 0.5, rise in HCO3 of 3, fall in glucose of 3 Catheterisation if urine not passed by 1hr NG if vomiting or drowsy LMWH K+ replacement if under 5.5 If under 3.5 ICU

Answer 62

``` Cerebral oedema Aspiration pneumonia Hypokalaemia Hypophosphataemia Thromboembolism Death ```

Answer 63

Hyperglycaemia caused by tissue resistance to pancreatic insulin 90% of people with diabetes have T2DM Monogenic variations: MODY and Mitochondrial

Answer 64

Genetic and environmental Obesity, Lack of exercise, HTN Pancreatic disease - Chronic pancreatitis Endocrine disease Drugs - Corticosteroids, Atypical antipsychotics, protease inhibitors

Answer 65

May be an incidental finding as it is often asymptomatic ``` Polyuria/Nocturia Polydipsia Glycosuria Polyphagia Tiredness ``` Hyperosmolar hyperglycaemic state (HHS) - 2(Cations) + Glucose + Urea - Dry brain (Corrected slowly) High central adiposity HTN Diabetic foot problems

Answer 66

HbA1c - >48mmol (6.5) Fasting plasma glucose ->6.9 Random plasma glucose - >11.1 2hr plasma glucose - >11.1

Answer 67

Pregnancy woman have high blood glucose usually in 3rd trimester

Answer 68

Diet and exercise + Metformin Aiming for 48 (6.5) Once HbA1c gets to 58 (7.5) Move to next level Add 1 of the following (Target <53): (Dual therapy) - Sulphonylureas (Gliclazide) - Ideal - Gliptins - DPP-4 inhibitors - Thiazolidinedione (Pioglitazone) If HbA1c gets to 58 (7.5) again move to next level Triple therapy (Target <53): - Metformin + Sulphonylurea + Gliptin - Metformin + Sulphonylurea + Pioglitazone - Insulin based therapy If triple therapy fails of is contraindicated Incretins (Exenatide) can be used with Metformin + Sulphonylurea if: - BMI >35 - BMI <35 - Weight-loss beneficial or Insulin effect on occupation Continued if weight loss of 3% in 6 months and HbA1c decrease of 11 (1%) Contraindication to metformin: SC SGLT2 inhibitors (Flozins) may be appropriate for some adults when metformin is contraindicated though Sulphonylureas and Pioglitazone would be indicated before SGLT2 inhibitors. You would however use a SGLT2 inhibitors over a Gliptin as monotherapy. Dual therapy should be a combination of the any 2 of the 3 1st line 1st intensification drugs Contra indications to pioglitazone: HF, Liver disease, DKA, Bladder cancer, Uninvestigated Marcoscopic Haematuria Insulin based therapy NPH insulin ideally If contraindicated Glargine or detemir

Answer 69

Macrovascular - Ischaemic heart disease - Stroke - PVD Microvascular - Neuropathy: Peripheral neuropathy - Glove and stockings distribution + Carpal tunnel + Gastroparesis + Other neuropathies - Nephropathy: Microalbuminuria + Proteinuria + Renal failure + Prone to UTI + Renal papillary necrosis - Retinopathy: Background, Pre-proliferative (Pan retinal photocoagulation), Proliferative (Pan retinal photocoagulation), Maculopathy HHS

Answer 70

Impaired fasting glucose (IFG) = Fasting glucose 5.6-6.9 Impaired glucose tolerance = Plasma glucose 7.8-11.0 Both give increased risk of T2DM

Answer 71

This is the release of excess serotonin and other vasoactive peptides into the systemic circulation from a carcinoid tumour Neuroendocrine tumours are responsible for this excess production and are usually located in the GUT Association with MEN-1 95% of patients with carcinoid syndrome have liver metastasis

Answer 72

Months of symptoms - Diarrhoea + Cramping - Flushing with stress and tyramine foods (Chocolate, banana, walnuts) - Wheeze - SOB - Raised JVP - Signs of RHF - RH murmurs - TR & PS - Hepatomegaly - RIF masses - Pellagra due to vitamin B3 (Niacin) deficiency

Answer 73

Serum Chromogranin A/B - Elevated Urinary Serotonin acid - Increased Metabolic Panel - Increased Creatinine CT scan Iodine I-123 MIBG Scintigraphy

Answer 74

It is a syndrome of: - Hyper-androgenaemia - Oligo/Amenorrhea - Polycystic ovarian morphology on US

Answer 75

- Hirsutism - Acne - Scalp hair loss - Weight gain - Irregular and infrequent periods - Infertility - HTN - Acanthosis nigricans - Sweating or oily skin

Answer 76

- Serum total and free testosterone - Elevated - Serum Dehydroepiandrosterone sulfate (DHEAS) - Elevated - Serum 17-hydroxyprogesterone - Normal - Serum Prolactin - Normal - Serum TSH - Normal Fasting glucose Fasting lipid panel Serum androstenedione - Elevated Pelvic US

Answer 77

This is reduced bone density defined as >2.5 standard deviations below the peak bone density of a normal young adult - T score > 2.5

Answer 78

Primary - Idiopathic if <50 - Post-menopausal Secondary - Myeloma + Metastatic carcinoma - Endocrine - Cushing's, Thyrotoxicosis, Primary Hyperparathyroidism, Hypogonadism - Drugs - Corticosteroid, heparin - Rheumatological - RA, AS - GI - Malabsorption, liver disease, anorexia

Answer 79

- Neck of femur fractures after minimal trauma - Vertebral fractures leading to loss of height, stooped posture, thoracic kyphosis - Tenderness on percussion - Colles fracture

Answer 80

DEXA Scan - Allows calculation of T-score (The number of standard deviations the bone mineral density measurement is above or below the young normal bone mineral density) and the Z-score (The number of standard deviations the bone mineral density measurement is above or below the age-matched mean bone mineral density) Isotope bone scans - Highlight areas of stress and micro fractures XR - Diagnose fractures +/- Biconcave Vertbrae +/- Crush fractures Bloods (Normal in primary osteoporosis): - Ca + Phosphate + ALP

Answer 81

Excessive bone remodelling at one or more sites resulting in bone that is structurally disorganised Common in the elderly

Answer 82

It may be asymptomatic - Insidious onset of pain aggravated by weight bearing and movement - Headaches - Deafness - Increasing skull size - Kyphosis - Anterolateral bowing of femur, tibia or forearm - Skin over the affected bone may be warm - Sensorineural deafness

Answer 83

XR - Early stages: Osteolytic changes; Late stages: Sclerotic Bone scan - Dense uptake ALP - Elevated Ca + Phosphate - Normal

Answer 84

Aside from the obvious ones Hypothyroidism Cushing's syndrome Insulinoma

Answer 85

BMI over 30. Morbid is over 40 BMI = Kg/m^2

Answer 86

- Headache - Visual field defects: Bitemporal Hemianopia - CN Palsies - Hypothalamic extension can lead to disorders in thirst and appetite, temperature regulation and consciousness

Answer 87

PFTs Visual fields MRI Pituitary

Answer 88

This is an autoimmune disorder that causes hyperthyroidism Thyroid stimulating immunoglobulin binds to the TSH receptor causing production of T3 and T4

Answer 89

Thyrotoxicosis - Weight loss - Increased appetite - Heat intolerance - Tachycardia - Palpitations - Arrhythmia - Diarrhoea - Sweating - Anxiety - Insomnia - Hair loss Graves' specific: - Smooth Enlargement (Lymphocyte Infiltration) - Goitre - Exophthalmos - Opthalmoplegia - Pretibial myxoedema - Thyroid acrpoachy: Clubbing, Painful finger and toe swelling Association to T1DM, Vitiligo, Addison's

Answer 90

TSH - Suppressed T3 and T4 - Elevated Thyroid stimulating antibodies - +ve Radioactive iodine I-123 or Tc-99 uptake scan - Diffuse uptake

Answer 91

- Differentiated - Act like normal thyroid tissue - Papillary is most common then follicular - Medullary - Type seen in MEN - Anaplastic - Rare

Answer 92

All more common in women Papillary - 20-40yrs Follicular - 40-50yrs Anaplastic - Elderly

Answer 93

- Slow-growing neck lump - Discomfort swallowing - Hoarse voice - Palpable nodules or diffuse enlargement of the thyroid gland - Cervical lymphadenopathy

Answer 94

TSH: Normal US Neck FNA Cytology CT/MRI - for staging Isotope scan - If cause of thyroid lump is unclear

Answer 95

Vast majority are benign but a small portion turn into thyroid cancer Most adenomatous and most are multiple Usually non-functioning

Answer 96

TSH: Normal US Neck FNA Cytology CT/MRI - for staging Isotope scan - If cause of thyroid lump is unclear

Answer 97

Catecholamine producing tumour that usually arise from chromatin cells of the adrenal medulla 10% Bilateral 10% Malignant 10% are extra-adrenal

Answer 98

30% MEN 2a Von Hippel-Lindau syndrome Neurofibromatosis type 1

Answer 99

Paroxysmal episodes - Headache - Sweating - Pallor - Fever - Weight loss Cardiorespiratory symptoms - Palpitations - Chest pain - Dyspnoea - HTN - Tachycardia GI symptoms - Epigastric pain - N - Constipation Neuropsychiatric symptoms - Weakness - Tremor - Anxiety

Answer 100

24Hr Urine collection - Check catecholamine levels (Metanephrines, normetanephrines and creatinine) Serum free metanephrines and normetanephrines Plasma catecholamines Genetic testing CT/MRI OR I-123 MIBG scintigraphy

Answer 101

All autosomal dominant MEN-1 (MEN1 gene mutation) - Pituitary - Parathyroid - Pancreatic islet-cell - Gastrinomas - Fascial angiofibromas and collagenomas MEN-2a (RET proto-oncogene mutation) - Parathyroid - Medullary thyroid cancer - Phaechromocytomas MEN-2b Same as 2a - Marfanoid appearance - Neuromas of the GI tract

Answer 102

MEN-1 - Diagnosis 4th decade - Depending on organ affected + Pituitary tumours may cause visual defects MEN 2 - Depending on organ affected

Answer 103

MEN 1 Chromogranin A - NET Gastrin - Gastrinoma IGF-1 - Pituitary MEN 2 Calcitonin - Medullary thyroid tumour Carcinoembryonic antigen - Medullary thyroid tumour

Answer 104

This is impaired ovarian function

Answer 105

1o - Gonadal dysgenesis (Turner's) - Gonadal damage (Autoimmune, chemotherapy, radiotherapy) 2o - More common - Functional (Stress, weight loss, excessive exercise, eating disorder) - Pituitary/Hypothalamic tumours and infiltrative lesion (Pit adenoma, haemochromatosis) - Hyperprolactinaemia - Congenital GnRH deficiency: Kallmann's syndrome, idiopathic

Answer 106

Oestrogen deficiency: - Night sweats - Hot flushing - Vaginal dryness - Dyspareunia - Decreased libido - infertility Signs Pre-Pubescent - Delayed puberty (Primary amenorrhoea, absent breast development, no secondary sexual characteristics) - Eunuchoid (Long legs, arm span greater than height) Post-Pubescent - Regression of secondary sexual characteristics - Perioral and periorbital fine facial wrinkles - Signs of underlying cause Kallmann's - Anosmia Turner's - Short stature - Low posterior hairline - High arched palate - widely spaced nipples - Wide carrying angle - Short 4th and 5th metacarpals - Congenital lymphoedema

Answer 107

Low serum oestradiol Serum FSH/LH - High in Primary. Low in secondary Primary - Karyotype - Pelvic US/MRI - In primary amenorrhoea - Screen for FMR1 gene in patients with unexplained pre-mature ovarian failure Secondary - Pituitary function test - Visual fields - Hypothalamic-pit MRI - Smell tests for anosmia - Serum transferring saturation (Haemochromatosis)

Answer 108

A syndrome of decreased testosterone production, sperm production or both

Answer 109

1o - More common - Gonadal dysgenesis (Klinefelter's syndrome, Undescended testicles) - Gonadal damage (Infection, torsion, trauma, autoimmune, iatrogenic) - Defects in enzymes involved in testosterone synthesis 2o - Pituitary/Hypothalamic tumours and infiltrative lesion - Hyperprolactinaemia - Congenital GnRH deficiency: Kallmann's syndrome, idiopathic - Prader-Willi syndrome (Short, small hands, almond-shaped eyes, learning difficulties, postnatal hypotonia) - Laurence-Moon-Biedl syndrome (Obesity, polydactyly, retinitis pigmentosa, learning difficulties)

Answer 110

Delayed puberty Decreased libido Impotence Infertility Signs Pre-Pubescent - Delayed puberty (High pitched voice, no secondary sexual characteristics, Small or undescended testicles, Small penis) - Eunuchoid (Long legs, arm span greater than height) - Gynaecomastia Post-Pubescent - Regression of secondary sexual characteristics - Soft and small eyes - Gynaecomastia - Fine personal wrinkles - Signs of underlying cause

Answer 111

Early morning serum testosterone on 2 separate occasions in a symptomatic man Sex hormone binding globulin Albumin LH and FSH 1o - Low testosterone, High LH and FSH 2o - Low testosterone, Low LH and FSH Primary Karyotyping Secondary - Pituitary function test - Visual fields - Hypothalamic-pit MRI - Smell tests for anosmia - Serum transferring saturation (Haemochromatosis)

Endocrine Flashcards

(135 cards)